Reviews

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Common Neuro-Ophthalmic Pitfalls: Case-Based Teaching

By Valerie A Purvin and Aki Kawasaki (£58.00, Cambridge University Press, 2009)

Reviewed by Dr Sacha Moore, consultant ophthalmologist

This book is part of a series of similar case-based books on different specialties, and is enjoyable and well written. If you are tired of didactic reference textbooks that serve up boring writing on layers of indigestible tedious lists and tables, like sawdust on bread and crackers, then this will be the cheese and grapes that render neuro-ophthalmology not just palatable but more-ish.

Let’s be honest: most of us non-neuro-ophthalmic specialists shy away from this subject and typically look for the nearest exit or window to jump through when a patient presents with double vision and headaches. Patients almost never present with textbook findings and almost always have confusing, subtle and variable symptoms or signs. This makes for a long corridor of bear traps, at the end of which awaits your own headache and diplopia if you are not careful.

This book will help you better understand subjects you thought you knew and those you know you didn’t know

The authors have nicely addressed the main subjects that cause anxiety amongst clinicians in neuroophthalmology and use real cases with relevant pictures and simple tables. There are 12 chapters:

When ocular disease is mistaken for neurologic disease

When orbital disease is mistaken for neurologic disease

Mistaking congenital anomalies for acquired disease

Radiographic errors

Incidental findings (seeing but not believing)

Failure of pattern recognition

Clinical findings that are subtle

Misinterpretation of visual fields

Neuro-ophthalmic lookalikes

Over-reliance on negative test results

Over-ordering tests

Management misadventures.

The style feels like a rewarding one-on-one tutorial and makes you feel like you may actually be able to deal with similar cases in future. You can dip into it like a textbook or enjoy reading it straight through from start to finish – there are many interesting and surprising facts that I have not found in other textbooks.

This book will help you better understand subjects you thought you knew and those you know you didn’t know. Neuro-ophthalmologists will find this book serves as a good tune-up on their knowledge; non-neuro-ophthalmologists may benefit from the insights, like a full service on the rusting remains of their faded membership memories. It is satisfyingly clinically relevant and not just another book for membership examinations.

Overall the book deserves the honour of being well-thumbed and to stand battered and frayed from much use amongst the shiny, thick bibles of untouched neuro-ophthalmic monoliths in your, or your institution’s, library.

Errornomics: Why We Make Mistakes and What We Can Do To Avoid Them

By Joseph T Hallinan (£8.99 Ebury Press, 2009)

Reviewed by Dr Matthew Sargeant, consultant psychiatrist and clinical human factors group member

I learnt so much from this easy-to-read, enjoyable little book. Why We Make Mistakes is available as paper book, ebook or audio book. How we look at things without seeing, forget things in seconds, and are all pretty sure we are way above average are the themes. Such themes are of immediate contemporary clinical relevance to practice and comprehensively described.

The book is good for everyone, whether on a course on clinical human factors or not. For more than 20 years Hallinan, a journalist, collected many errors and obtained comments from academics who study various aspects of human performance and psychology related to human error-making. There are many helpful references, a guide to chapters and footnotes.

The book is an invaluable primer for academic literature for human factors/ergonomics terminology. Grouped deceptively simply under 13 chapters, we are told making fewer mistakes is not easy, especially if the reader merely desires to do so without reflection. Hallinan urges: put effort into thinking of the small things we do and do not do, for the consequences are big.

We are told making fewer mistakes is not easy, especially if the reader merely desires to do so without reflection

To improve patient safety with the very next patient you manage, read the book. The book advises team members to work together, to communicate and to have a supportive and accessible attitude to reduce error in team members. Clinicians are also advised to look up at the organisation they are working in for the sources of errors, as well as down at what they are doing. Clinicians are also told to avoid multitasking.

The book implies that designing, investigating, delivering and managing clinical care are onerous responsibilities to promote patient safety. The book is a lifeline for all medical students and doctors who make the plaintive cry “why don’t they teach us about human factors”. If there are any non-believers about human fallibility out there it will help them too. Patients could help too by reading the book to [help] their clinicians.

Hallinan tells us confidence and expertise attained through years of practice and study can be a major context of error. We are all fallible, the book says. To err is, indeed, human. Clinicians, buy it: be a good doctor and make patients safer. Patients: buy it and help your doctor deliver to you safer clinical care.

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